Women have outlived men for more than a century in the U.S. Demographers have largely attributed this well-known statistical gap to differences in behaviors in areas such as smoking and drinking habits, risk of injury and drug use. Overall U.S. life expectancy had been slowly improving for decades, but data from the Centers for Disease Control and Prevention show some of this progress has recently been overturned—especially among men.
In 2010 women were projected to live 4.8 years longer than men. By 2021 this gap widened to 5.8 years, the largest disparity since 1996. During the 20th century, heart disease was the main cause of death that created the difference in life expectancy among women and men. But now COVID fatalities and a growing number of drug overdoses among men are to blame, according to a new analysis of CDC data published in JAMA Internal Medicine. (The report designated gender based on binary gender data that were recorded in death certificates.)
A greater number of COVID deaths among men—influenced by a higher burden of comorbidities, differences in health behaviors and employment in higher-risk industries—was a big part of the “deeply troubling” drop in life expectancy and widening gender gap, says Philip Cohen, a professor of sociology at the University of Maryland, who was not involved in the study. “But this report underscores some underlying public health problems that also disproportionately affect men, especially drug overdoses, suicide and other violence.”
Before the pandemic, in the years between 2010 and 2019, the largest contributor to the gap was the category of unintentional injuries—mostly drug overdoses but also transport-related injuries such as car accidents. Other factors included rising rates of diabetes, suicides, homicides and heart disease. All of these increased the life expectancy gap by 0.23 year.
The most substantial change in projected life expectancy at birth occurred between 2019 and 2021: the onset of the COVID pandemic. Death from the widespread illness was a major factor in decreasing men’s average life expectancy to 73.2 years in this period, compared with 79.1 years in women. This was on top of already higher rates of death from unintentional injuries—which were, again, overwhelmingly drug overdoses.
The discrepancy is “unsettling,” says Brandon Yan, lead author of the new analysis. Overall life expectancy has been declining since COVID—from 78.8 years in 2019 to 76.1 years in 2021—“which is concerning in and of itself,” says Yan, a resident physician at the University of California, San Francisco, School of Medicine, and a research collaborator at the Harvard T. H. Chan School of Public Health.
Yan and his colleagues were initially surprised that men had a disproportionate COVID mortality burden. “Part of the [reason] is men, on average, are sicker than women” when they contract COVID, he says.
Sarah Richardson, who directs the GenderSci Lab at Harvard University and was not involved in the study, says the findings were consistent with her previous research that found a small increase in COVID mortality among men, compared with women. “So the results are not surprising from that perspective,” Richardson says. The trend was even more pronounced in younger populations, she adds.
Deaths at a younger age have an exaggerated effect on life expectancy calculations, says Elizabeth Wrigley-Field, an associate professor of sociology at the University of Minnesota, who did not participate in the recent research. Most people who die from opioid overdose, for example, should have had decades left to live, she says. “That's why each of those deaths can really affect the population life span or life expectancy in a meaningful way,” Wrigley-Field adds, “more so than for causes of death that tend to kill people at much older ages.”
The gender gap was slightly offset by improvements in cancer survival rates in men, as well as worsening rates of maternal deaths—a growing public health problem nationwide. “It's similarly something that has a profound, disproportionate impact on life expectancy,” Wrigley-Field says, “because the women are at a relatively young age, when they should have had many decades to live.”
Previous research has attributed biological factors, such as a more robust immune system, to women’s relative longevity. But this cannot explain such a significant change in life expectancy in the span of the analysis from 2010 to 2021, Yan says. The changes over such a short period come down to increasing rates of chronic disease burden among men and the worsening mental health crisis, he says.
The reason why COVID and overdose-related mortality had worsened to such an extent among men might have to do with occupation and health care access, Richardson says. She adds that masculinity norms and pressures may prevent some men from complaining that they’re in pain or in need of care. “It is much less likely for men to appear for care before a situation is very acute, and so they have poorer outcomes,” she says. Yan adds that risk factors such as being unhoused or working in construction or agriculture—both situations in which men constitute the overwhelming majority—have been associated with increased exposure to COVID.
Donald Miller, an epidemiologist at the Boston University School of Public Health and a co-author of the new analysis, says persuading more older men to get vaccinations would improve the life expectancy trend. But, he adds, “the bigger challenge is younger men.” More research into the reasons behind men’s riskier health behaviors is needed to develop better interventions for drug misuse, violence and suicide. Cohen says preventative care, mental health care and earlier detection would help alleviate these areas.
The recent analysis used death certificate data, which lack specificity beyond a binary gender classification. The report also didn’t account for location, race or socioeconomic factors—which Richardson says may reveal vast discrepancies among those subgroups. Her previous analysis of COVID deaths, for instance, showed mortality rates varied significantly on a state-by-state level. Yan is awaiting the release of life expectancy data for 2022 later this month and hopes the additional information will help future studies on demographic factors that may influence the gender disparity.
The trends that reflect more deaths among men and countervailing trends such as increased maternal mortality are happening in the U.S.—which has a significantly higher overall mortality rate than its peer countries, Wrigley-Field says. “The right starting point for asking why any particular group in the U.S. has such high mortality is to ask why the entire United States does,” she says.
The answer isn’t simple; poverty, overwork, a lack of safety nets, a fragmented medical system and daily stressors could all play a role. But the truth is probably something like “all of the above,” Wrigley-Field says.
“These trends should be a wake-up call that we can't coast along toward better and longer lives,” Cohen says. “We need real, substantial and sustained attention to public health and health care in this country—and we need it yesterday.”
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